Individual
JENNIFER LYNN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATR-BC,L-CAT
Contact information
Practice address
NICHOLS RD, STONY BROOK, NY 11794-0001
(631) 444-1051
Mailing address
55 LAKE SHORE DR, RONKONKOMA, NY 11779-3154
(631) 648-8740
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
000775-1
NY
Other
Enumeration date
02/14/2014
Last updated
02/14/2014
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